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-   -   Reasons to avoid ketosis (http://forum.lowcarber.org/showthread.php?t=404248)

Nancy LC Fri, Nov-27-09 13:09

Reasons to avoid ketosis
 
Interesting look at ketosis from a low carber.

http://high-fat-nutrition.blogspot....of-ketosis.html

Altari Fri, Nov-27-09 13:42

I'm going to go out on a limb here and say I got absolutely nothing from that post. Can someone please offer a CliffNotes version?

Bexicon Fri, Nov-27-09 14:01

It is interesting.

Nancy LC Fri, Nov-27-09 17:41

Quote:
Originally Posted by Altari
I'm going to go out on a limb here and say I got absolutely nothing from that post. Can someone please offer a CliffNotes version?

Without spending too much time on it the points were:

Ketosis can shrink kidney stones. If you have a big unpassable kidney stone it's relatively harmless. If it shrinks it can get stuck in a place that causes excruciating pain.

Ketosis can cause heart rhythm irregularities if you have certain heart conditions. Maybe just temporarily.

Ketosis may cause fasting hyperglycemia (high blood sugar) in some people.

Ketosis may cause cramping in some people. Sometimes taking minerals helps.

The author then goes on to say he doesn't worry about it, he drifts in and out of ketosis all the time (we all do every night anyway).

The biggest difference is low carbers tend to make it a 24 hour a day thing versus something you're doing a few hours a night.

mike_d Fri, Nov-27-09 17:57

Quote:
Ketosis can cause heart rhythm irregularities if you have certain heart conditions. Maybe just temporarily.

Ketosis may cause fasting hyperglycemia (high blood sugar) in some people.

Ketosis may cause cramping in some people. Sometimes taking minerals helps.
And it can turn your blood to battery acid :lol:

I haven't had Hyperglycemia, but I have had reactive hpoglycemia after fasting then eating a big meal -- my sugar drops into the 50's or 60's after about an hour or two. Drinking alcohol and taking certain BP meds (beta blockers) can make it worse.

PilotGal Fri, Nov-27-09 19:22

it's too bad we can't sue bloggers for libel.

M Levac Fri, Nov-27-09 20:25

Quote:
If you are wired for a heart problem along the lines of Wolff Parkinson White Syndrome, cranking up your adrenaline and noradrenaline levels might not be a good idea. If you have atrial fibrillation, ditto.

Yeah, I guess those few should be real careful with their diet, if they're not careful already. If they're not, it doesn't matter, they probably won't know what hit them. So it's not a real problem either way.
Quote:
So I have some respect for the potential for the complications of ketosis, especially sudden onset. There are undoubtedly many plus sides, but nothing is ever completely problem free.

Yeah (oh noze, sarcasm yet again), I guess sugar is so much better in terms of healthful effects.

He did start by saying that it was his opinion. I give him that, at least.

teaser Fri, Nov-27-09 22:53

Quote:
The effects of physiological levels of 3-hydroxybutyrate on noradrenaline binding to rat erythrocyte membranes were studied. The binding of noradrenaline to membranes was determined by measuring the union of 3H-noradrenaline in the presence of varying concentrations of 3-hydroxybutyrate. Scatchard plots of the results were used to determine that 3-hydroxybutyrate provoked a loss of affinity of the 2-adrenergic receptors for adrenaline. Thus high (but physiological) 3-hydroxybutyrate levels can lower the binding of the catecholamine, thus diminishing the extent or intensity of adrenergic-driven responses


http://www3.interscience.wiley.com/...ETRY=1&SRETRY=0


It makes sense for the ketogenic diet to cause an increase in adrenaline, noradrenaline and cortisol. These hormones encourage lipolysis and fat burning and an increase in ketones. It makes equal sense for ketones to be involved in a feedback mechanism that decreases the action of those hormones, to keep lipolysis and ketone formation from going beyond what is actually necessary for the body's present needs. Physiologic hormone resistance.
------------------------------------------------------------------

http://www.ncbi.nlm.nih.gov/pubmed/7719390


Quote:
The aim of this work was to investigate the changes of cardiac performance by both electrocardiography (ECG) and echocardiography (ECHOc), in addition to anthropometric and hormonal variables before, during and after prolonged total fasting (TF) and re-feeding in an overweight adult man. Physical examination, laboratory and hormonal measurements, ultrasonographic study of body fat distribution, ECG and ECHOc study were performed before during and after 34 days of TF and after 17 days of isocaloric re-feeding. The subject was a 52-year old Caucasian who was overweight with increased abdominal fat content (BMI: 28.6; W/H ratio: 0.95) and increased levels of arterial systolic and diastolic blood pressure (SBP, DBP). HPLC measurements of urinary catecholamine levels (HPLC), ECHOc study of cardiac performance, ultrasonographic study of body fat distribution were performed. The subject starved for 34 days losing 22kg, but after that time he was compelled to re-feed because of nausea and severe vomiting. A marked ketosis (ketonuria > 1200mg/day) was already present after 6 days of TF. After 17 days of TF norepinephrine (NE) and epinephrine (EPI) urinary levels showed a two-fold and nine-fold increase respectively, but they became undetectable at the end of TF. After 17 days of re-feeding catecholamine urinary levels were similar to those measured after 17 days of TF. After both TF and 17-day isocaloric re-feeding we found a decrease of visceral fat content and W/H ratio reached the normal values for age-matched subjects (W/H ratio after TF: 0.80, after re-feeding: 0.80)


Just working from the abstract again here. Peter commented on the red letters;

Quote:
So increased sympathetic tone seems to be a feature of both fasting as well as ketogenic eating. It does look as if the effect is transient during fasting, so this may also be the case in ketogenic eating, but I have no data on that. The fact it may well be transient is no consolation if you have been admitted to a cardiology ward via A&E due to severe palpitations!


Urinary levels of adrenaline and noradrenaline were high half way through the fast at seventeen days; but the fast wasn't stopped then. The real concern came at the end of thirty four days, when the subject got nauseous and these hormones were undetectable in the urine. If this guy was six feet tall, at a bmi of 28.6 then he started at 211 pounds, if the online calculator I'm using works right. 22 kg is 48.4 pounds, so that's 162.6 pounds the guy was down to at the end of the fast. If he was six feet. If he was any shorter, it's worse. And he'd have to be awfully tall to make 48.4 pounds a reasonable amount of weight to lose in a total fast at that starting bmi.

I need to know more about these hormones, they seem to tie in with stage fright, social anxiety and all that. Weren't we looking at a study about a month ago dealing with ketones and post traumatic stress disorder?

Okay. Propranolol is sometimes used for stage fright. Propranolol is a beta blocker, it blocks the action of adrenaline and noradrenaline. So I guess ketones are a beta blocker too? I know which medicine I'd choose.

In this study here,

Blood pressure and norepinephrine spillover during propranolol infusion in humans


Quote:
Arterial plasma norepinephrine levels rose from 183 +/- 20 to 250 +/- 29 pg/ml during propranolol (P less than 0.001), suggesting increased sympathetic vasoconstrictor tone. However, isotope dilution studies using tritiated norepinephrine infusion showed that arterial plasma levels of tritiated norepinephrine rose from 743 +/- 78 to 1,002 +/- 101 dpm/ml during propranolol (P less than 0.001), indicating a reduction in the rate of norepinephrine clearance from plasma. The calculated fall in clearance from 1.90 +/- 0.13 to 1.42 +/- 0.11 1/min (P less than 0.001) entirely accounted for the rise in plasma norepinephrine, since the calculated rate of norepinephrine spillover into plasma remained at the base-line level of 340 +/- 40 ng/min during propranolol.


norepinephrine in the serum increases, as its uptake is blocked. Because its uptake is blocked.

I wish they'd just stick to the word ''adrenaline.'' Epinephrine doesn't have the same oomph.

amergin Sat, Nov-28-09 10:18

Quote:
Originally Posted by Nancy LC
Without spending too much time on it the points were:

...................
Ketosis may cause fasting hyperglycemia (high blood sugar) in some people.
...................


Interesting link Nancy.
Just to focus on the point above. I find it very interesting.
I have followed the link in your referenced article and will start a new thread on this subject alone.

amergin Sat, Nov-28-09 10:56

The "randle effect" Low-carb may cause insulin resistance
 
Following on from thread
http://forum.lowcarber.org/showthre...797#post7957797

I would like to focus on one Point in it that thread:

"...................
Ketosis may cause fasting hyperglycemia (high blood sugar) in some people.
..................."

The reference in Hyperlipid's post is

"OK, fasting hyperglycaemia. I have this mildly on a low carbohydrate, high saturated fat diet. My FBG is about 5.5mmol/l, ie 100mg/dl. I've discussed it here. http://high-fat-nutrition.blogspot....resistance.html

But I do know at least one person who can achieve a FBG of 8.0mmol/l on a deeply ketogenic diet. This is 144mg/dl and not a number that I would personally wish to sustain for any period of time. This is not a standard response to marked ketosis, but unless you are checking you blood sugar levels, how would you know that it wasn't your response? A few carbs should reverse this.
"

The latest post brings you here. (I've just posted the first section. Well worth a full read)

"Physiological insulin resistance
Back in mid summer 2007 there was this thread on the Bernstein forum. Mark, posting as iwilsmar, asked about his gradual yet progressively rising fasting blood glucose (FBG) level over a 10 year period of paleolithic LC eating. Always eating less than 30g carbohydrate per day. Initially on LC his blood glucose was 83mg/dl but it has crept up, year by year, until now his FBG is up to 115mg/dl. Post prandial values are normal.

He wanted to know if he was developing diabetes.

I've been thinking about this for some time as my own FBG is usually five point something mmol/l whole blood. Converting my whole blood values to Mark's USA plasma values, this works out at about 100-120mg/dl. Normal to prediabetic in modern parlance. However my HbA1c is only 4.4%, well toward the lower end of normality and healthy. That's always assuming that I don't have some horrible problem resulting in very rapid red blood cell turnover. I don't think so..."

And ..

"However, while muscles are in "refusal mode" for glucose the least input, from food or gluconeogenesis, will rapidly spike blood glucose out of all proportion. This is fine if you stick to LC in your eating. It also means that if you take an oral glucose tolerance test you will fail and be labelled diabetic. In fact, even a single high fat meal can do this, extending insulin resistance in to the next day. Here's a reference for this.
http://www.ncbi.nlm.nih.gov/sites/e...Pubmed_RVDocSum
"


This article has links to related articles in the right hand tab that references:
Impairment of glucose tolerance in normal adults following a lowered carbohydrate intake.
http://www.ncbi.nlm.nih.gov/pubmed/10622209?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItem Supl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
(I can't get this link to work)

This starts to get very interesting.
The last ref'd article shows insulin resistance in 3 out of twelve and 2 out of 8 test subjects on a low-carb diet for one and three days respectively.

The questions this raises for me are what causes some and not others to experience this.
Also whether elevated blood glucose in a subject showing this effect is as harmful as elevated blood glucose in other situations.
Lastly, whether this varying response may be related to the varying experiences related on these boards to VLC (Very Low Carb) and moderate carb diets like South Beach etc.


There's many other related links I found interesting, but I'll leave it at that for now.

Nancy LC Sat, Nov-28-09 11:02

Peter also remarks that a high FBG in a low carber is just a temporary IR state. As soon as you eat something you lose the IR and deal with the incoming glucose/protein and your post-meal BG will be shiny.

http://high-fat-nutrition.blogspot....resistance.html

He states the difference is that a diabetic is permanently IR because they have high insulin levels and low carber is just IR when they're fasting and only because they have such low insulin levels.

So how do you know which sort you are? I suppose get a fasting insulin test next time they check your fasting BG.

M Levac Sat, Nov-28-09 16:37

Blood glucose is regulated up or down depending on the needs of the body. Consequently, normal isn't fixed nor is it the same for everybody. However, it's a measure, rather naive measure you'd say, of whether a person has diabetes type 2. Now that we know about normal physiological insulin resistance induced by a high fat diet, which is otherwise completely healthful, then the resulting blood glucose measurement should be viewed as normal, whatever that measure is. A GTT is a rather archaic method of determining if a person's glycolysis pathways are disrupted, i.e. we overload the pathways and see if it returns to normal in a pre-determined "normal" time. Let's see if we could do this with the pain pathways of our various organs like, I dunno, hit somebody on the head with a hammer and check how much pain he feels.

The point is that blood glucose varies for several reasons, only some of which are due to disease.

mike_d Sat, Nov-28-09 17:56

About one to two hours after I eat after fasting my glucose drops to about 60. My FBS is normally 87 - 88.

LC FP Sat, Nov-28-09 18:35

Amergin, this is truly interesting stuff. I was embarrassed by a FBS of 105 a few months ago and was afraid to repeat it. Now I want to repeat it along with an insulin level and maybe a HBA1c. If I have "physiological" insulin resistance I wonder if there are any implications and like you I wonder why others don't have the same results.

poke Mon, Nov-30-09 23:24

Surprised by some of the negative responses. This is Peter the Hyperlipid guy we're talking about, not a Cheerios-eating standard-issue dietitian. I don't think it's that unreasonable to discuss a few short-term and long-term issues that pop up with ketosis in some people.

I would like to have seen him talk a little about possible long-term thyroid downregulation on ketogenic diets. I can't find all that much information on it, possibly because there isn't much apart from scattered anecdotal reports.


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